| Med-peds Associates,p.c. | |
|
375 N Wall St Ste P520 Kankakee IL 60901-3483 | |
| (815) 933-0194 | |
| (815) 933-1444 |
| Full Name | Med-peds Associates,p.c. |
|---|---|
| Speciality | Pediatrics |
| Location | 375 N Wall St, Kankakee, Illinois |
| Authorized Official Name and Position | Stonewall Mccuiston (PRESIDENT) |
| Authorized Official Contact | 8159330194 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Med-peds Associates,p.c. 375 N Wall St Ste P520 Kankakee IL 60901-3483 Ph: (815) 933-0194 | Med-peds Associates,p.c. 375 N Wall St Ste P520 Kankakee IL 60901-3483 Ph: (815) 933-0194 |
| NPI Number | 1063538312 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 10/20/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063538312 | NPI | - | NPPES |
| 036074737 | Medicaid | IL | |
| 4623239 | Other | IL | BLUE CROSS/BLUE SHIELD OF ILLINOIS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036074737 (Illinois) | Secondary |
| 208000000X | Pediatrics | 036074737 (Illinois) | Primary |
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